功能试验用于鉴别多囊卵巢综合征患者过多雄激素的来源

Functional tests to differentiate the source of androgens in polycystic ovary syndrome patients

为探索简便易行、适用于临床鉴别多囊卵巢综合征（ＰＣＯＳ）过多雄激素来源的方法，对１１例雄激素增高的ＰＣＯＳ患者进行雄烯二酮（Ａ２）与皮质醇（Ｆ）的同步释放试验、地塞米松抑制试验及舒经酚刺激试验，随后进行舒经酚诱导排卵治疗，对舒经酚耐药者辅以地塞米松治疗。结果：（１）４例Ａ２与Ｆ的同步变化不明显，地塞米松对Ａ２的抑制也不明显，舒经酚刺激后Ａ２及雌二醇（Ｅ２）升高明显，舒经酚诱导排卵７个周期中５个周期排卵，提示过多雄激素主要来源于卵巢。（２）７例Ａ２与Ｆ的同步变化明显，地塞米松对Ａ２明显抑制，舒经酚刺激后Ａ２及Ｅ２升高不明显，舒经酚诱导排卵１３个周期中仅２个周期排卵。辅以地塞米松治疗后，２例排卵并获妊娠，表明过多雄激素除卵巢外，兼有肾上腺来源。提示综合舒经酚刺激试验与地塞米松抑制试验，以Ａ２及Ｅ２为指标，可用于鉴别ＰＣＯＳ患者过多雄激素的不同来源，同步释放试验对鉴别也有一定意义，雄激素基础水平的测定对鉴别意义不大。

 Objectives: To explore simple and practical methods to differentiate the source of hyperandrogenism in polycystic ovary syndrome (PCOS) patients.Design: Eleven hyperandrogenic PCOS patients and 14 normal controls were included in this study. The basic levels of testosterone, total and free, androstenedione (A2), DHEAS, LH, FSH, cortisol(F), and estradiol (E2) were measured, and pelvic ultrasonography was performed in all cases. Corcomitant releasing test of A2 and F, dexamethasone (DEX) suppression test and clomiphene stimulating test were performed and followed with 1～3 courses of clomiphene citrate (CC) 100 mg/d×5. Low dose DEX 0.5mg/d were added to CC failure cases.Results: In 4 of 11 cases, serum A2 level was less concomitant with F, suppression by DEX was not significant, but A2 and E2 increased significantly during with clomiphene stimulating test. Ovulation was induced successfully with a rate of 71.4%. In the remaining 7 cases, the concomitant test showed changes in A2 and F, serum A2 level was suppressed after DEX and no significant increase of A2 and E2 after clomiphene stimulation, the ovulation rate was only 15.4%. Addition of DEX increased ovulation in 2 and became pregnant.Conclusion: The levels of A2 and E2 in both the DEX suppression test and clomiphene stimulating test may be used in differentiating the source of hyperandrogens in PCOS patients, the former indicating ovarian and the latter companied with adrenal origin. The concomitant releasing test might be of some help, but the measurement of basic levels of androgens showed no significance in differentiation.